Monday, October 2, 2017

A Dynamic Approach to ACL Rehabilitation and Prevention: Part V - A Guest Blog

Over the last couple of weeks, we have talked about Dynamic Tape and how it may be used for rehabilitation.  But how does this work in practice?  Let's look at a case study.

Trent Nessler’s Athletic Movement Index and DorsaVi vs. Keith Cronin and Dynamic Tape
I have said a lot about Dynamic Tape and how a Biomechanical Taping solution should be in every clinician’s tool belt. So, to wrap up this series I decided to take on Trent Nessler’s Athletic Movement Index for ACL assessment measured by DorsaVi.

Patient History
Throwing HIPPA out the door here. 😊
This test subject is an exceptional handsome, intelligent, and all around amazing 35-year old male who enjoys running and is beat up badly by his 6 and 3-year-old daughters every day. His relevant list of injuries from playing years of sports and now becoming his children’s human pony include: 
  • 3 concussions 
  • R/L torn hamstrings (multiple times) 
  • 13 total sprained ankles (I was never meant to play basketball) 
  • L lower leg anterior compartment syndrome  
  • L3/L4 “Dead disc” with L myotome weakness since age 17 
  • L piriformis pain (multiple times)  
  • 5-year history of tingling sore legs (disc related but not current) 
  • 3 sprained ribs  
  • Separated L Shoulder (4x) 
  • Severe strain to L coracobrachialis (did not even know this was possible) 
  • Multiple rotator cuff and elbow strains from baseball 
  • Flat spine from weakness in thoracic

At the outset, you would agree that I am walking disaster and should not be allowed to do anything moving faster than a jogging pace. Regardless, I wanted to prove I could make it through this testing while only crying and whining a moderate amount.

Round 1 – Baseline

Started off with a solid assessment that revealed I have terrible front control and difficulty with eccentrically loading, as indicated by the speed. I have no history of ACL issues but from all this you can easily conclude I fall into a “high risk” category. The varus positioning is likely compensation because of weak hip abductors and a slight general “bow” leggedness.

NOTE: What is not included is my 100% passing score for the abdominal / lower back strength testing. Take that AMI!

Round 2 – Quad Taping
Please note at this point I have gone through the entire AMI, cried in the corner, and come back to the testing. My legs are already tired but knowing that the L is a concern, I decided to go ahead with the testing. We started with the quad taping to see what affect it would have.

What we found was a little improvement with the single leg squat, more so with the single leg jump, but then the dynamic jumps showed what Dynamic Tape has been talking about for years. Dynamic Tape is a viscoelastic product, meaning the faster a body part moves, the faster and stronger it stiffens to resist motion. This fast, dynamic movement is what is most relevant with ACL rehabilitation.

You can see from this testing that frontal plane motion improved from 25 to 19 degrees with Dynamic Tape. Please note that taping the extensor mechanism deceased varus / valgus excursion. Quad control = knee control. From testing we know my low back and abdominals are working but with a history of myotome weakness on the L it is not shocking there isn’t a lot of push in it. Depth of squat decreased a little, likely because feeling the stiffening of the tape brought on a sensation earlier to control it. Rate of speed decreased a fair bit, bringing it from BAD back to ACCEPTABLE.

I went into this fatigued, meaning I should be losing control and I was GAINING IT! With my L leg now exhausted, I went ahead to prove the point even more.

Round 3 – Hip Taping
I decided to do a THIRD round of testing on the L side, now with the hip rotation taping. I did the taping over my pants so you could see where tape was going. Normally, this would be flush against the skin but ain’t no one needs to see my skinny, pale booty. 😊

Another 5-6 minutes of tears and sobbing and we had some data. My leg was completely shot at this point and going home afterwards it felt like my two-story townhome was a skyscraper of stairs.
From the original baseline, you remember that I had a very varus position. What did this show? A return to varus, which makes perfect sense! I did a hip extension / ER rotation taping that pulled me into that position. This means in open chain the hip is being pushed into external rotation, increasing the opportunity for varus on landing. So far, this makes sense. Not what I want but mechanically this is consistent with everything Dynamic Tape does.

Now look at the rate of control. How is it that after my third round of testing my rate of control is excellent? Now what I didn’t tell you was with the L plank exercises about 20 seconds in my L butt cheek was burning bad. I said I had L side myotome weakness for years so hip abductors on that side don’t have the stamina and activation they should. The hip external rotation taping gave my weak rotators and abductors a little help resulting in significant improvement in control.

I believe enough in this product to put myself through Trent’s utter soul crushing AMI DorsaVi module and through it, I hope you see what I and many clinicians around the world have been seeing for years. Using the Biomechanical Taping System of Dynamic Tape allows the clinician to:
  • Reduce Workload
  • Management Movement Patterns 
  • Improve Function

all while allowing your patient to move 100%, to restore appropriate body mechanics.

From these movement assessments, research, and reasoning I hope you will consider putting Dynamic Tape in your toolkit for ACL rehab. Waiting for an injury to occur is not a prerequisite. Dynamic Tape can manage movement patterns and improve function before an injury occurs. In concert with a quality assessment, sound reasoning, and a purposeful rehabilitation game plan, Dynamic Tape offers any clinician the opportunity to elevate rehabilitation and injury prevention to new heights.

Want to learn more about Dynamic Tape or DorsaVi? Please contact Keith J. Cronin, DPT, OCS, CSCS at or visit the website at

NOTE: Big thanks to Trent Nessler for allowing me the opportunity guest write on his blog, as well as to Shawna Jamison with DorsaVi for showing helping me with testing and for holding back the sarcastic comments as I struggled to walk. 

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu. 

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